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    <title>健康知识调查表</title>
    <style>
        body {
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            margin: 20px;
            background-color: #f9f9f9;
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        h1, h2 {
            text-align: center;
            color: #333;
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        form {
            background-color: #fff;
            padding: 20px;
            border-radius: 8px;
            box-shadow: 0 0 10px rgba(0, 0, 0, 0.1);
        }
        label {
            font-weight: bold;
            margin-right: 10px;
        }
        input[type="text"], input[type="radio"] {
            margin-bottom: 10px;
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        table {
            width: 100%;
            border-collapse: collapse;
            margin-bottom: 20px;
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        th, td {
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            padding: 12px;
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        th {
            background-color: #f2f2f2;
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            font-weight: bold;
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            margin-bottom: 10px;
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            display: block;
            width: 100%;
            padding: 10px;
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            cursor: pointer;
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        .submit-btn:hover {
            background-color: #45a049;
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    </style>
</head>
<body>

<h1>上海市嘉定区中心医院</h1>
<h2>健康知识调查表</h2>

<form>
    <label for="bed-number">床号:</label>
    <input type="text" id="bed-number" name="bed-number"><br><br>

    <label for="name">姓名:</label>
    <input type="text" id="name" name="name"><br><br>

    <label for="age">年龄:</label>
    <input type="text" id="age" name="age"><br><br>

    <label for="hospital-number">住院号:</label>
    <input type="text" id="hospital-number" name="hospital-number"><br><br>

    <label for="education">文化程度:</label>
    <input type="text" id="education" name="education"><br><br>

    <label>首次住院:</label>
    <input type="radio" id="first-time-yes" name="first-time" value="yes">
    <label for="first-time-yes">是</label>
    <input type="radio" id="first-time-no" name="first-time" value="no">
    <label for="first-time-no">否</label><br><br>

    <label>住院时间:</label>
    <input type="radio" id="admission-day" name="admission-time" value="day">
    <label for="admission-day">入院当天</label>
    <input type="radio" id="admission-later" name="admission-time" value="later">
    <label for="admission-later">住院第</label>
    <input type="text" id="admission-day-number" name="admission-day-number">
    <label>天</label><br><br>

    <div class="section-title">一、疾病知识方面</div>
    <table>
        <tr>
            <th>问题</th>
            <th>1分</th>
            <th>2分</th>
            <th>3分</th>
            <th>4分</th>
            <th>5分</th>
        </tr>
        <tr>
            <td>您了解您的疾病吗？</td>
            <td><input type="radio" name="disease-knowledge-1" value="1"></td>
            <td><input type="radio" name="disease-knowledge-1" value="2"></td>
            <td><input type="radio" name="disease-knowledge-1" value="3"></td>
            <td><input type="radio" name="disease-knowledge-1" value="4"></td>
            <td><input type="radio" name="disease-knowledge-1" value="5"></td>
        </tr>
        <tr>
            <td>您知道引起您疾病的原因吗？</td>
            <td><input type="radio" name="disease-knowledge-2" value="1"></td>
            <td><input type="radio" name="disease-knowledge-2" value="2"></td>
            <td><input type="radio" name="disease-knowledge-2" value="3"></td>
            <td><input type="radio" name="disease-knowledge-2" value="4"></td>
            <td><input type="radio" name="disease-knowledge-2" value="5"></td>
        </tr>
        <tr>
            <td>您知道该疾病发病时的症状吗？</td>
            <td><input type="radio" name="disease-knowledge-3" value="1"></td>
            <td><input type="radio" name="disease-knowledge-3" value="2"></td>
            <td><input type="radio" name="disease-knowledge-3" value="3"></td>
            <td><input type="radio" name="disease-knowledge-3" value="4"></td>
            <td><input type="radio" name="disease-knowledge-3" value="5"></td>
        </tr>
        <tr>
            <td>您知道该疾病发病时处理方法吗？</td>
            <td><input type="radio" name="disease-knowledge-4" value="1"></td>
            <td><input type="radio" name="disease-knowledge-4" value="2"></td>
            <td><input type="radio" name="disease-knowledge-4" value="3"></td>
            <td><input type="radio" name="disease-knowledge-4" value="4"></td>
            <td><input type="radio" name="disease-knowledge-4" value="5"></td>
        </tr>
        <tr>
            <td>您知道该疾病有哪些治疗方法吗？</td>
            <td><input type="radio" name="disease-knowledge-5" value="1"></td>
            <td><input type="radio" name="disease-knowledge-5" value="2"></td>
            <td><input type="radio" name="disease-knowledge-5" value="3"></td>
            <td><input type="radio" name="disease-knowledge-5" value="4"></td>
            <td><input type="radio" name="disease-knowledge-5" value="5"></td>
        </tr>
        <tr>
            <td>您知道您门诊复查的重要性吗？</td>
            <td><input type="radio" name="disease-knowledge-6" value="1"></td>
            <td><input type="radio" name="disease-knowledge-6" value="2"></td>
            <td><input type="radio" name="disease-knowledge-6" value="3"></td>
            <td><input type="radio" name="disease-knowledge-6" value="4"></td>
            <td><input type="radio" name="disease-knowledge-6" value="5"></td>
        </tr>
    </table>

    <div class="section-title">二、运动方面</div>
    <table>
        <tr>
            <th>问题</th>
            <th>1分</th>
            <th>2分</th>
            <th>3分</th>
            <th>4分</th>
            <th>5分</th>
        </tr>
        <tr>
            <td>您知道您适合哪些运动吗？</td>
            <td><input type="radio" name="exercise-1" value="1"></td>
            <td><input type="radio" name="exercise-1" value="2"></td>
            <td><input type="radio" name="exercise-1" value="3"></td>
            <td><input type="radio" name="exercise-1" value="4"></td>
            <td><input type="radio" name="exercise-1" value="5"></td>
        </tr>
        <tr>
            <td>您知道您运动的时候要注意什么吗？</td>
            <td><input type="radio" name="exercise-2" value="1"></td>
            <td><input type="radio" name="exercise-2" value="2"></td>
            <td><input type="radio" name="exercise-2" value="3"></td>
            <td><input type="radio" name="exercise-2" value="4"></td>
            <td><input type="radio" name="exercise-2" value="5"></td>
        </tr>
        <tr>
            <td>您知道运动时出现不适该如何处理吗？</td>
            <td><input type="radio" name="exercise-3" value="1"></td>
            <td><input type="radio" name="exercise-3" value="2"></td>
            <td><input type="radio" name="exercise-3" value="3"></td>
            <td><input type="radio" name="exercise-3" value="4"></td>
            <td><input type="radio" name="exercise-3" value="5"></td>
        </tr>
        <tr>
            <td>您知道运动的益处吗？</td>
            <td><input type="radio" name="exercise-4" value="1"></td>
            <td><input type="radio" name="exercise-4" value="2"></td>
            <td><input type="radio" name="exercise-4" value="3"></td>
            <td><input type="radio" name="exercise-4" value="4"></td>
            <td><input type="radio" name="exercise-4" value="5"></td>
        </tr>
    </table>

    <div class="section-title">三、遵医嘱服药方面</div>
    <table>
        <tr>
            <th>问题</th>
            <th>1分</th>
            <th>2分</th>
            <th>3分</th>
            <th>4分</th>
            <th>5分</th>
        </tr>
        <tr>
            <td>您了解您服用的药物的作用吗？</td>
            <td><input type="radio" name="medication-1" value="1"></td>
            <td><input type="radio" name="medication-1" value="2"></td>
            <td><input type="radio" name="medication-1" value="3"></td>
            <td><input type="radio" name="medication-1" value="4"></td>
            <td><input type="radio" name="medication-1" value="5"></td>
        </tr>
        <tr>
            <td>您知道您服用的药物的副作用吗？</td>
            <td><input type="radio" name="medication-2" value="1"></td>
            <td><input type="radio" name="medication-2" value="2"></td>
            <td><input type="radio" name="medication-2" value="3"></td>
            <td><input type="radio" name="medication-2" value="4"></td>
            <td><input type="radio" name="medication-2" value="5"></td>
        </tr>
        <tr>
            <td>您知道规律用药重要性吗？</td>
            <td><input type="radio" name="medication-3" value="1"></td>
            <td><input type="radio" name="medication-3" value="2"></td>
            <td><input type="radio" name="medication-3" value="3"></td>
            <td><input type="radio" name="medication-3" value="4"></td>
            <td><input type="radio" name="medication-3" value="5"></td>
        </tr>
        <tr>
            <td>您知道您药物的服用方法吗？</td>
            <td><input type="radio" name="medication-4" value="1"></td>
            <td><input type="radio" name="medication-4" value="2"></td>
            <td><input type="radio" name="medication-4" value="3"></td>
            <td><input type="radio" name="medication-4" value="4"></td>
            <td><input type="radio" name="medication-4" value="5"></td>
        </tr>
        <tr>
            <td>您知道自己服用药物的注意事项吗？</td>
            <td><input type="radio" name="medication-5" value="1"></td>
            <td><input type="radio" name="medication-5" value="2"></td>
            <td><input type="radio" name="medication-5" value="3"></td>
            <td><input type="radio" name="medication-5" value="4"></td>
            <td><input type="radio" name="medication-5" value="5"></td>
        </tr>
    </table>

    <div class="section-title">四、生活习惯方面</div>
    <table>
        <tr>
            <th>问题</th>
            <th>1分</th>
            <th>2分</th>
            <th>3分</th>
            <th>4分</th>
            <th>5分</th>
        </tr>
        <tr>
            <td>您知道吸烟醒酒对身体危害吗？</td>
            <td><input type="radio" name="lifestyle-1" value="1"></td>
            <td><input type="radio" name="lifestyle-1" value="2"></td>
            <td><input type="radio" name="lifestyle-1" value="3"></td>
            <td><input type="radio" name="lifestyle-1" value="4"></td>
            <td><input type="radio" name="lifestyle-1" value="5"></td>
        </tr>
        <tr>
            <td>您知道规律作息的总处吗？</td>
            <td><input type="radio" name="lifestyle-2" value="1"></td>
            <td><input type="radio" name="lifestyle-2" value="2"></td>
            <td><input type="radio" name="lifestyle-2" value="3"></td>
            <td><input type="radio" name="lifestyle-2" value="4"></td>
            <td><input type="radio" name="lifestyle-2" value="5"></td>
        </tr>
    </table>

    <div class="section-title">五、饮食方面</div>
    <table>
        <tr>
            <th>问题</th>
            <th>1分</th>
            <th>2分</th>
            <th>3分</th>
            <th>4分</th>
            <th>5分</th>
        </tr>
        <tr>
            <td>您知道您目前适合什么样的饮食吗？</td>
            <td><input type="radio" name="diet-1" value="1"></td>
            <td><input type="radio" name="diet-1" value="2"></td>
            <td><input type="radio" name="diet-1" value="3"></td>
            <td><input type="radio" name="diet-1" value="4"></td>
            <td><input type="radio" name="diet-1" value="5"></td>
        </tr>
        <tr>
            <td>您知道在饮食方面您需要注意些什么吗？</td>
            <td><input type="radio" name="diet-2" value="1"></td>
            <td><input type="radio" name="diet-2" value="2"></td>
            <td><input type="radio" name="diet-2" value="3"></td>
            <td><input type="radio" name="diet-2" value="4"></td>
            <td><input type="radio" name="diet-2" value="5"></td>
        </tr>
        <tr>
            <td>您知道坚持规律、清淡的饮食习惯的好处吗？</td>
            <td><input type="radio" name="diet-3" value="1"></td>
            <td><input type="radio" name="diet-3" value="2"></td>
            <td><input type="radio" name="diet-3" value="3"></td>
            <td><input type="radio" name="diet-3" value="4"></td>
            <td><input type="radio" name="diet-3" value="5"></td>
        </tr>
    </table>

    <input type="submit" class="submit-btn" value="提交">
</form>

</body>
</html>